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Sunday, January 1, 2012

Liquid of Langerhans

Fellow diabetes blogger Kelly K reminded me the other day that, with the year's end approaching, it was time to refill my prescriptions. That brought a check of the fridge butter compartment and a realization that I was, in fact, on my last bottle of insulin.

Wait a sec...is that BUTTER in that butter compartment?! WTF?

I phoned in a refill late in the night a day before Christmas, so we vowed to avoid the next day's shopping craziness and pick it up after the holiday. Another day passed and Suzi grabbed it on the way home from work. All was good and I had another three bottles (one month's supply) safe and snug in the butter compartment. That was that and all was well with the world.

But after reading a recent post over at Six Until Me, my mind started working about that insulin lounging in the butter compartment. I got curious about the real cost of the life-sustaining medicine being pumped into my body on a daily basis. The real cost. Not the after-insurance "feel good" amount that takes away the reality of what it truly costs to have this life-sustaining, Liquid Langerhans.

My mission became clear. I had to know.

Unable to find the receipt showing said cost of just purchased insulin, we made a return trip to the local retail pharmacy to retrieve that financial 411. There was someone at the counter ahead of us, so I perused the nearby D-supply shelves and toyed with the idea of buying a home A1c test or snagging an extra jar of glucose tabs. Suzi snapped me back to reality once it was clear the Nice Pharmacist Guy was patiently eying us and waiting for us to approach the counter.

Me: "We were just in the other day refilling a prescription... well, actually, she was for one of my prescriptions... and we needed to get a copy of the bill showing the cost breakdown. Is that possible?"

NPG: "The co-pay amount?

Me: "Actually, the full retail cost before insurance. Does it have that?"

NPG: "Of course. Just a receipt? I can do that."

We laid out my identification and told him it was for the Humalog, and he quickly hit a button on the keyboard and made the printer came to life. NPG grabbed it and brought it over, asking if that's what I was looking for with the co-pay amount of $40 listed on it. I glanced at the top of the sheet, to the left of that amount, and saw in fine print a different line that said, "Retail Value: $419.99."

An internal "YIKES" tried to escape, but I suppressed the sticker-shock.

Me: "That does it. Thank you, very much."

He went about his pharmacist duties, and we left to walk around the rest of the store for a bit as my mind tried to process the D-Math of a different kind.

Looking at that number again, it simply astounds me - $420 a month, or $1,260 for a three-month supply of insulin. Geez, there must have truly been gold in that liquid of langerhans!

Of course, it's tough to not recognize and be VERY thankful that we have health insurance that wipes out a majority of that total. Luckily, I'm paying less than 10% of the total cost. For all it's woes and failings, insurance is an incredible blessing. I just hope that those without the option currently are someday soon able to get at least a taste of the coverage... (keep the health care reform, cough cough).

Anyhow, knowing the total cost of my insulin addiction, it was now time to check for money savings that might be available elsewhere. Doing some online research with our insurance company, I learned that getting a three-month supply of insulin through the mail order ExpressScripts (Medco, who?!?!) would save us about $20 a month ($80 per year).

Backstory: Through a previous insurance plan with a longtime employer, we had the luxury of a 90-day supply from the same retail pharmacy for about the same as it would have cost from out-of-state medical supply company, so that's the option we chose. Insurance changes in early 2010 switched up insurers (and decreased coverage) and capped the retail pharmacy supply at 30 days. I didn't have the energy at the time to switch to mail-order, and so I just stayed with the local shop. Fast forward to now. After Kerri's post, I wanted to know what it really cost to get insulin and whether there might be some money-saving options available elsewhere.

It looks like mail order might be on the horizon! There's something reassuring about having a butter compartment full of insulin, rather than being on that last bottle and bringing all the uncertainty of possibly running out or dropping and shattering it at the worst possible moment when BGs are sky high. So, once this monthly supply runs thin, it looks like we'll go after the mail-order method.

In a world where this Liquid of Langerhans appears to be laced with gold, any little savings helps out.

I get most of my prescriptions through Medco too. The other nice benefit is that they send email reminders in time to renew your prescriptions.

I have often wondered what the price to manufacture the insulin really is too. I have learned that it really does lose effectiveness after a month and have been throwing out what is left from the previous month as I open a new pen. I usually have to throw about half a pen's worth of the Novolog which bothers the conservative side of me. I only hope that most of what I am tossing is paying for the Research and Development of the product and not its physical components.

What a great post. With all the hoopla around potential cures and improved technologies, we need to remember that there are lots of people NOW (people in this very country) who are living with Type 1 diabetes and struggling to afford the basis (such as insulin and test strips). This stuff is expensive. I see too many posts from people on TuD who are type 1 and struggling to afford the insulin and test strips they need to survive.

I think it's because of insurance that there exist insulins- Humalog, I'm looking at you- that cost more but aren't better than regular.

NPH and Regular are for sale at roughly $60 for a thousand units at many pharmacies in the US, and the evidence suggests that other insulins have no more than a very small margin of improved performance (the biggest difference is in terms of how frequent nocturnal hypoglycemia is on Lantus vs NPH- NPH; the only new insulin that has been shown to lower A1cs is Novolog- and it lowers A1c by an average of between 0.1 and 0.2 percentage points) while costing 1.5 to 8 times as much.

In countries where companies other than Lilly and Novo are making NPH and Regular, the price for a thousand units of insulin is as low as $1.55 USD for a thousand units.In May 2010, Health Action International went into pharmacies worldwide and asked for the retail price (no insurance) of the cheapest 10 mL vial of U100 insulin in stock. In the four pharmacies in the US they went into, the four cheapest vials were all Humulin R and cost $51.95 to $54.49. At all the pharmacies I've checked at, Regular and NPH cost the same.

Also, in the US if you have no insurance and make less than 3x the poverty line, you can get insulin shipped to your doctor, free.

If I had no insurance, I would not be worried about my insulin. I could get my insulin for free, at my income level, and if my income was just over that limit, I could afford to spend the thousand dollars that a year's worth of NPH + Regular would cost (that's assuming 1 vial of NPH per month and 1 vial of Regular every other month- I currently use 35 units per day, 10 of Lantus plus 25 Regular). I would be more worried about testing my blood sugar. That would probably come out to over three thousand dollars- although I'm not sure what price the discount cards for low income people would get me.

I never knew the cost of insulin can be that high! You are lucky you have insurance to cover that for you. In my case, even the nasonex cost, which I barely had any idea how much until I lost my insurance, is now a far-fetched thing from the reality of my pocket. I hope the Obamacare gets rolled out soon enough. There's just too much burden in terms of healthcare in our country. Sadly but true.

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Mike Hoskins

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Just a guy in his 30s, who's been living with Type 1 diabetes since the age of five. A husband, friend, dog owner, journalist, writer, history lover, movie buff, Sigma Pi Man, and huge fan of Coffee & Conversation.

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